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Published on: August 28, 2020
Intractable voiding dysfunction in children with normal spinal imaging: predictors of failed conservative management.
Jonathan J Stone1, Curtis J Rozzelle, Saul P Greenfield
1Department of Neurosurgery and Urology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA.
Urology
|October 27, 2009
Summary
Most children with intractable voiding dysfunction do not resolve symptoms. Daytime wetting, uninhibited bladder contractions (UBCs), and detrusor-sphincter dyssynergia predict persistent symptoms in children.
Area of Science:
- Pediatric Urology
- Urodynamics
- Voiding Dysfunction
Background:
- Intractable voiding dysfunction in children poses a management challenge.
- Identifying predictive factors for treatment failure is crucial for optimizing care.
Purpose of the Study:
- To identify predictors of persistent voiding symptoms in neurologically normal children.
- To analyze presenting symptoms and video-urodynamic findings in relation to treatment outcomes.
Main Methods:
- Retrospective chart review of neurologically normal children with intractable voiding dysfunction.
- Analysis of urodynamic findings, presenting symptoms, and treatment outcomes.
- Long-term follow-up via chart review and mailed surveys.
Main Results:
- 66% of children remained symptomatic after a mean follow-up of 4 years.
- Uninhibited bladder contractions (UBCs) with daytime wetting were associated with a failure to normalize (77.4%).
- UBCs and detrusor-sphincter dyssynergia significantly predicted persistent symptoms (P = .02).
Conclusions:
- The majority of children with intractable voiding dysfunction do not achieve symptom resolution.
- Daytime wetting, UBCs, and detrusor-sphincter dyssynergia are key indicators of poor prognosis.
- Consideration of aggressive alternative therapies may be warranted for high-risk patients.
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